A Crummy Day

Parent Cafe
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<p>I’m having a whine and cheese party.</p>

<p>Yesterday I attended the funeral home visitation of a woman in my Bible Study who finally lost her 9-year wrestling match with a brain tumor, leaving behind two kids, 13 and 10. </p>

<p>I came home from that to find a notice from our insurance company denying my daughter’s $650 emergency room claim. (See the “get it off your chest” thread.)</p>

<p>My H got home and I was still fighting with insurance, and hadn’t fixed any supper. So we went out for dinner. And while we were eating, a teenage girl walked in the restaurant and asked who owned the green Prizm she just hit. We do.</p>

<p>There are sunny sides to these stories. My friend was one of the most upbeat, inspirational people I have ever been blessed to know. My D indeed did not have a life-threatening illness (although how they expect 18 year olds to pre-diagnose, I don’t know. Imagine watching my D pass out in the dorm bathroom, and thinking she needed medical care! Silly dorm mates.) And - very low on the list, admittedly - I’m glad we drove the old Prizm and not the new Mini last night. And the girl who hit our car is the daughter of a friend, and I have confidence that all will be well. And a lady walked up to us as we were leaving the restaurant because she wanted to congratulate us on how well we handled the situation with the car, and if her kid was ever in that situation, she hoped her kid would get to deal with folks like us. So that made me feel good.</p>

<p>If anybody has any advice about the ER insurance, I’d love to hear it. I will contact the hospital today, and try to see if they can re-file the claim. If not, I will appeal it myself. But it really seems ridiculous to base payment on the diagnosis rather than the symptoms. </p>

<p>Today is my S1’s 25th birthday! Today will be better, because I got the bad stuff over with yesterday. Right?</p>

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<p>Oh, binx, I’m sorry you had such a sad and frustrating day, and I certainly hope that your D is okay. I don’t understand how the insurance company can refuse the ER bill in that instance (another post for the healthcare thread!). </p>

<p>Today is sure to be better for you! Happy birthday to your son!</p>

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<p>First, Happy 25th to your oldest son!</p>

<p>I am so sorry about your day. As far as the insurance, it sounds like your IC is out of line. We have had emergency room visits that ended up not being life and death emergencies and the bill was fully paid. We have a $100 copayment for an ER so that might have something to do with it. Your D could have fainted from a variety of health problems and her dormmates did take proper action IMO. It isn’t until a complete workup is done that one could say it was not an emergency. My H went into an ER when we were out of town because of a bad earache. It was an ear infection, and ER bill was paid. The doc in the ER first ruled out that wasn’t having or about to have a heart attack. I guess there was a small chance that it could have been his heart causing pain in his ear (people having heart attacks can get referred pain to the jaw, the left arm too). We knew this was unlikely since he was diagnosed with an ear infection a month earlier. Our reason for going to an ER is that we were out of town so we did not have access to our primary care physician, it was late at night, and my H was in a lot of pain. Back to your D-did your insurance company expect your D to refuse treatment in an ER when her dormmates sought emergency medical care? Did the insurance company expect her to just leave the ER? It is wonderful that there wasn’t anything seriously wrong with your D, but there there could have been.</p>

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<p>Does your insurance have a requirement of first checking with the primary care doc? They may have denied the claim on that basis. However, I think that you can point to the exigent circumstances; loss of consciousness is generally a reason to eliminate the need for the primary care doc. Not to mention the fact that your d’s primary care doc is likely nowhere near her when she’s in school.</p>

<p>Good luck with this, and enjoy your son’s birthday!</p>

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<p>This happened in late January. We got a phone call at 7:00 in the morning, from the roommate, explaining that D had passed out in the bathroom and they were taking her to ER. D was conscious at the time, and we were able to speak with her. She was very weak. She had had what she thought was a cold all week long, but had been going to classes, rehearsals, etc. She hadn’t felt all that bad. She was getting ready for classes when she fainted. We had no idea what was wrong.</p>

<p>The letter we got from the insurance company said the “the information we have does not support the definition of an emergency.” But no where on the letter does it say what information they have. So I called them to see what they knew and what they didn’t. The agent I spoke with was – I can’t think of a nice word for idiot… First all she would do was read that line to me. I told her I could read that; that I needed more info. Then she told me “Your policy clearly states that flu is not an emergency.” Whatever I said to her, she just repeated that line to me - using the broken record method to shut me up. I asked for a supervisor, who came on the line and said, “I understand my agent has explained to you that your D’s situation was not an emergency.” To which I responded, “Yes, which surprises me, since she wasn’t there.”</p>

<p>After I explained the situation (which the first agent wouldn’t allow me to do), she said that she agreed with me that it was an emergency, but that the hospital had filed it an a non-emergency. I am not sure I believe her, since the hospital filed a level 4 (of 5) charge against us. With level 1 being the “basic emergency care”. If it wasn’t an emergency, why are we being charged like it is?</p>

<p>The doctors did not believe it was flu when she came in; they said the symptoms didn’t match. Only after they did the swab were they able to diagnose it. So how are 18 year olds supposed to diagnose it?</p>

<p>I have a call into the hospital - line was busy. Hopefully they will resubmit and I won’t have to do anything else. I wonder though, if it is company policy to deny every claim where the person walks out alive, just as a matter of course, and hope a fair number of patients don’t appeal.</p>

<p>Chevda - no, our insurance doesn’t require a primary care physician. But in Oxford, there are only two medical care options - the hospital or the school clinic, and the clinic wasn’t open. By the way, they are run by the same people.</p>

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<p>And some people claim we have good healthcare in this country or that seeking dramatic ways to fix it will result in inefficient socialized medicine. Look at what your premiums are paying for: you’ve run into two people (whose salary your premiums pay for) who spend their time figuring out ways to tell you you aren’t going to get covered for something that is manifestly and emergency. This is a bureaucracy, and not just one that’s incompetent, but one that is dedicated to treating you like he**.</p>

<p>I saw a posting on one of the other threads that cited a study showing we pay on average $1,500 more per person in this country for healthcare compared to comparable nations, that we cover far fewer and that the healthcare we get is substandard in general.</p>

<p>Sorry to turn this into something political, but this is not an isolated incident. A healthcare company in California was fined $9 million this week for denying coverage it ought to have provided.</p>

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<p>I got a return call from the hospital. It was actually billed as a level 3, not 4. (I only have the total; haven’t gotten a bill from the hospital, and judged level by the total. But some of it was lab fees.) I asked her why it was a level 3, if the hospital then told the insurance company it wasn’t an emergency. Seems like it should have at most been billed for “basic emergency care - level 1.” She said they DID file it as an emergency. So somebody’s lying, since the insurance supervisor told me the hospital said it wasn’t.</p>

<p>The billing office is sending it back to the ER for review, to make sure they filed at the appropriate level. They will get back to me in a few days, and then I will have to write the appeal. They said they filed everything appropriately. The only thing I picked up on is that they didn’t mention she had fainted - but of course, she was conscious in the ER, so they only write what they see.</p>

<p>I absolutely agree that the whole medical / insurance system is broke. I just am not sure how to fix it.</p>

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<p>Perhaps the hospital did file it as a non-emergency, but to your daughter’s dormmates it looked like an emergency. The fact that your D lost consciousness could be an emergency. Supposing she decided not to check this out, and she fainted again, but the next time she was on the top of staircase, or behind the wheel of a car! Your D and the others did the prudent thing, and then your D was released after diagnosis. I don’t get it. Your D did visited the ER with the medical concerns that an average layperson might have. It was quite reasonable and appropriate in my opinion. I would not let it go. We had to fight with our IC 13 years ago for some ongoing treatment that they tried to deny for one of our children. My H is an attorney so for us the battle was affordable and worth it, but it was inconvenient and stressful. We did prevail and the IC did end up paying.</p>

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<p>I still think there should be a notation as to the reason for the ER visit, history of having fainted just prior to coming into the ER. They don’t have to witness your daughter fainting. They could state that your D or her friends stated that she had lost consciousness.</p>

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<p>hey binx - I won’t try to get into the whole ER/Insurance thing, I just want to congratulate you on having a son who turns 25 today…</p>

<p>That is a HUGE positive that outweighs every other possible negative in your life that you can think of! Wow! That’s just great! What a blessing!</p>

<p>There are so many people in the world who can’t/didn’t have kids, and they’ve missed out on something you’ve been able to enjoy every single day for 25 years now! (and I shudder to think of the ones who have lost kids before they turned 25!).</p>

<p>And I know you know all this - I just wanted to give you a little “cyber hug” and remind us all that, no matter what happens, if we have health & family (an living in America too!), we are waaay to the good!</p>

<p>I know bad stuff happens in life, but doesn’t that make us appreciate all the “good stuff”? And don’t we all really have a lot of that!</p>

<p>(Boy, I sure hope this doesn’t sound “preachy” or anything - I only mean it in the best, most encouraging way possible!).</p>

<p>Cheers!
~BZ</p>

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<p>Binx: I haven’t read everything here, but let me jump in: It is likely that the diagnostic code the hospital put on your daughter’s bill to the ins co is not a emergency code. How it was billed (ie, Level 3-type thing) is just the hospital’s way of charging. The ins co looks at the diagnosis or the symptoms, and if the code says it was “flu,” the ins co can reasonably deny it. What you need to do is ask the hsopital to resubmit the bill with a diagnostic code of “fainting” or “unconscious” or some such, so the inc co recognizes it was a legitimate emergency.</p>

<p>I do employee benefits for a living and run into this not infrequently. Good luck.</p>

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<p>Thanks, VeryHappy. I am also guessing that is what happened. The hospital billing person told me it was marked with several things - all flu symptoms, I guess. I asked about including the fainting incident, since that was the presenting symptom - the reason she came. The billing lady told me that I should say that in my appeal. She said it would be illegal for her to change anything.</p>

<p>I told her I wasn’t asking her to lie; just asking her to be accurate. But all she agreed to do was send it to the ER for review, and get back to me in a couple days.</p>

<p>I’ve started writing my appeal in the meantime, so I don’t forget the facts. Probably good that I have to wait a couple days, since right now I’m being way too sarcastic. Eventually I will get it pared down to facts only.</p>

<p>BZ - no offense taken. As you may have read in my original post, I did attempt to see the bright side. I almost posted this last night when it happend, but I read through a few other threads, such as LatetoSchool’s, and knew mine paled in comparison. But then, this morning, I decided that I could use some support, and some CC wisdom, so posted anyway.</p>

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<p>Hey binx!
So sorry for the no-good-very-bad day(s). I can probably help you with the insu. stuff if you’d like-- but the first thing I’d do right now is have your husband speak to the head of HR at his company. Don’t waste your time with the benefits dept-- they won’t do anything. HR, however, wants to know when the insu carrier they pay mistreats their employees. If you can, an email to the TOP of HR is the best thing. Dont dilly dally with some low level person. Just start with “we are loyal and dedicated employees of XXXX co and we have been unable to get the medical services to which we are entitled” and document the problem, dates of conversations, name of people with whom you spoke, etc. Short and sweet, but to the point. That makes things happen. As for the appeals process that you should be doing simultaneously, email me and I’ll give you some suggestions.</p>

<p>Sorry about the car-but glad it wasnt the mini!! My dad’s caregiver took his car to the market and hit another car in the parking lot! The car she hit happened to be the wife of the rabbi of the nearby synagogue! Its always something!</p>

<p>Happy 25th to your oldest!! And, FWIW, I am still smiling about the adjective you used to describe me to mythmom!</p>

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<p>Thanks, jym - I appreciate the advice, and I’ll holler if I need help with the appeal.</p>

<p>But what I really want to know is what adjectives you’ve used to describe me! Or maybe I don’t…</p>

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<p>Sorry for the bad day. Odd how some days just seem to be filled with mishaps that seem to just keep piling up.</p>

<p>Reality check, I don’t think that her daughter necessarily got poor healthcare, just a raw deal from her insurance company. I don’t agree that our country has poor health care, not the best insurance coverage and processing of claims.</p>

<p>Either way binx, I hope that you can resolve the issue with your insurance company and you DID handle that car accident very well. A lesser peron may have snapped under the pressure of your bad day.</p>

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<p>binx- I didn’t need to describe you to mythmom-- she’d already met you! And did you see my comment in the “NY meet-up” thread? I was wearing my late mom’s jewelry the day you and I had lunch. She was the one with taste!</p>

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<p>I wanted to send a good vibe to both you and the young lady who hit your car. Plenty of teenagers would not have come into the restaurant to seek out the person she’d damaged. I think that shows real courage and maturity. I’m glad you didn’t get mad at her.</p>

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<p>In the last two weeks my husband and I have been deluged with similar billing shenanigans from multiple sources. I’m beginning to think that the economy is so bad that individuals and businesses (hospitals and insurance companies included) are getting desperate. It takes lots of time and energy to challenge them all. Your poor car being hit was just rotten luck. So sorry!</p>

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<p>Yeah, just got a call from a bill collector for an insurance copay I mailed in November. For $32! Times are getting hard. The guy was desperate for me to give him my credit card number. HA! Happily, I had the EOB and my copy of the bill labeled when I pad it.</p>

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<p>(responding to post about the young driver) Yes, after the fact, I wondered if my own kids would have known what to do. My guess is that they would have called us first, to ask. According to our church directory, she is still 16 for a couple more months. </p>

<p>My H walked out with her to look at the cars. When they came back, she asked us what to do, and I asked her who owned the car. She said her dad did, and I asked if she’d called him yet. She hadn’t, so I said she needed to. And I told her that the very first words out of her mouth needed to be “I’m okay.” She talked to her dad, told him she was sorry a couple of times, and also told him she swung into the parking place too fast. No excuses or anything. I was proud of her. Then my H talked to him, and everybody stayed friendly, albeit embarassed to be having the discussion.</p>

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<p>Another thanks to Binx for not getting angry at the teenaged girl who hit her car! Several weeks ago my 17-yr-old daughter had a fender-bender and slid into the car in front of her, who at the last minute decided not to make a turn. The roads were very icy and no one would have been able to stop–the brakes had no traction. My D called me in hysterics, didn’t know what to do (even though I printed out a list of exactly what to do, who to call, etc. in the event of an accident and put it in her glove box) and the last thing she needed was someone yelling at her! The driver of the other car was very calm and understanding and made my D feel so much better.</p>